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Microangiopathy of Progressive Systemic Sclerosis: Evaluation by Dynamic Fluorescence Videomicroscopy

Microangiopathy of Progressive Systemic Sclerosis: Evaluation by Dynamic Fluorescence... Abstract • Morphologic changes of the nail-fold capillaries have been studied extensively in progressive systemic sclerosis (PSS). With videomicroscopy after intravenous injection of fluorescein sodium as a tracer, a more accurate morphologic description became possible, including data on the pericapillary interstitial space and the measurement of transcapillary diffusion of dye (videodensitometry). The results in 13 patients with PSS and Raynaud's phenomenon were compared with those obtained in 12 healthy volunteers. The diameters of the patients' nail-fold capillaries were significantly increased. The normal barriers for diffusion of the dye are located at the capillary wall and at the outer border of the skin papilla (halo). Both were less effective in PSS, with significantly enhanced fluorescent light intensities in the juxtacapillary region and outside of the halo. "Streetlike" or "lakelike" areas are stained in the remote parts, demonstrating abnormal architecture of the interstitial space. The technique could facilitate early detection of PSS. (Arch Intern Med 1986;146:1541-1545) References 1. Norton WL, Nardo JM: Vascular disease in progressive systemic sclerosis. Ann Intern Med 1970;73:317-324.Crossref 2. Porter JM, Snider RL, Bardana EJ, et al: The diagnosis and treatment of Raynaud's phenomenon. Surgery 1975;77:11-23. 3. Rodnan GP: Progressive systemic sclerosis and penicillamine. J Rheumatol 1981;8( (suppl 7) ):116-120. 4. Mahler F, Bollinger A: Die Kapillarmikroskopie als Untersuchungsmethode in der klinischen Angiologie. Dtsch Med Wochenschr 1978;103:523-527.Crossref 5. Maricq HR, Downey JA, Le Roy EC: Standstill of nailfold capillary blood flow during cooling in scleroderma and Raynaud's syndrome. Blood Vessels 1976;13:338-349. 6. Maricq HR, Le Roy EC, D'Angelo WA, et al: Diagnostic potential of in vivo capillary microscopy in scleroderma and related disorders. Arthritis Rheum 1980;23:183-189.Crossref 7. Vaissairat M, Priollet P: Atlas Pratique de Capillaroscopie . Paris, Editions de la Revue de Médecine, 1983. 8. Jayson MIV: Systemic sclerosis: A collagen or microvascular disease? Br Med J 1984;288:1855-1857.Crossref 9. Mahler F, Saner H, Marth D, et al: Local cold exposure test for examination of the nailfold capillary circulation in Raynaud's syndrome. Inter Angio 1983;2:137-142. 10. Meier B, Mahler F, Bollinger A: Blutflussgeschwindigkeit in Nagelfalzkapillaren bei Gesunden und Patienten mit vasospastischen und organischen akralen Durchblutungsstörungen. Vasa 1978;7:194-198. 11. Bollinger A, Jäger K, Roten A, et al: Diffusion, pericapillary distribution and clearance of Na-fluorescein in the human nailfold. Pflugers Arch 1979;382:137-143. 12. Bollinger A, Frey J, Jäger K, et al: Patterns of diffusion through skin capillaries in patients with long-term diabetes. N Engl J Med 1982;307: 1305-1310.Crossref 13. Franzeck UK, Isenring G, Frey J, et al: Eine Apparatur zur dynamischen intravitalen Videomikroskopie. Vasa 1983;12:233-238. 14. Jäger K, Geser A, Bollinger A: Videodensitometrische Messung der transkapillären Passage und Gewebsverteilung von Na-Fluoreszein in menschlichen Hautkapillaren. Vasa 1980;9:132-136. 15. Bollinger A, Jäger K: Trans- and pericapillary diffusion of Na-fluorescein in scleroderma and chronic venous incompetence. Bibl Anat 1981;20:679-683. 16. Dagher FJ, Lyons JH, Finlayson DC, et al: Blood volume measurement: A critical study prediction of normal values: Controlled measurement of sequential changes. Adv Surg 1965;1:69-109. 17. Odland GF: The fine structure of cutaneous capillaries , in Montagna EW, Ellis RA (eds): Advances in Biology of Skin . Elmsford, NY, Pergamon Press Inc, 1961, vol 2, pp 57-70. 18. Intaglietta M, Johnson PC: Principle of capillary exchange , in Johnson PC (ed): Peripheral Circulation . New York, John Wiley & Sons Inc, 1978, pp 141-166. 19. Franzeck UK, Isenring G, Frey J, et al: Videodensitometric pattern recognition of Na-fluorescein diffusion in nailfold capillary areas of patients with acrocyanosis, primary and secondary Raynaud's phenomenon. Inter Angio 1983;2:143-152. 20. Chen Z-Y, Silver RM, Ainsworth SK, et al: Association between fluorescent antinuclear antibodies, capillary patterns, and clinical features in scleroderma spectrum disorders. Am J Med 1984;77:812-822.Crossref 21. Harper FE, Maricq HR, Turner RE, et al: A prospective study of Raynaud's phenomenon and early connective tissue disease: A five-year report. Am J Med 1982;72:883-888.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Microangiopathy of Progressive Systemic Sclerosis: Evaluation by Dynamic Fluorescence Videomicroscopy

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Publisher
American Medical Association
Copyright
Copyright © 1986 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1986.00360200103017
Publisher site
See Article on Publisher Site

Abstract

Abstract • Morphologic changes of the nail-fold capillaries have been studied extensively in progressive systemic sclerosis (PSS). With videomicroscopy after intravenous injection of fluorescein sodium as a tracer, a more accurate morphologic description became possible, including data on the pericapillary interstitial space and the measurement of transcapillary diffusion of dye (videodensitometry). The results in 13 patients with PSS and Raynaud's phenomenon were compared with those obtained in 12 healthy volunteers. The diameters of the patients' nail-fold capillaries were significantly increased. The normal barriers for diffusion of the dye are located at the capillary wall and at the outer border of the skin papilla (halo). Both were less effective in PSS, with significantly enhanced fluorescent light intensities in the juxtacapillary region and outside of the halo. "Streetlike" or "lakelike" areas are stained in the remote parts, demonstrating abnormal architecture of the interstitial space. The technique could facilitate early detection of PSS. (Arch Intern Med 1986;146:1541-1545) References 1. Norton WL, Nardo JM: Vascular disease in progressive systemic sclerosis. Ann Intern Med 1970;73:317-324.Crossref 2. Porter JM, Snider RL, Bardana EJ, et al: The diagnosis and treatment of Raynaud's phenomenon. Surgery 1975;77:11-23. 3. Rodnan GP: Progressive systemic sclerosis and penicillamine. J Rheumatol 1981;8( (suppl 7) ):116-120. 4. Mahler F, Bollinger A: Die Kapillarmikroskopie als Untersuchungsmethode in der klinischen Angiologie. Dtsch Med Wochenschr 1978;103:523-527.Crossref 5. Maricq HR, Downey JA, Le Roy EC: Standstill of nailfold capillary blood flow during cooling in scleroderma and Raynaud's syndrome. Blood Vessels 1976;13:338-349. 6. Maricq HR, Le Roy EC, D'Angelo WA, et al: Diagnostic potential of in vivo capillary microscopy in scleroderma and related disorders. Arthritis Rheum 1980;23:183-189.Crossref 7. Vaissairat M, Priollet P: Atlas Pratique de Capillaroscopie . Paris, Editions de la Revue de Médecine, 1983. 8. Jayson MIV: Systemic sclerosis: A collagen or microvascular disease? Br Med J 1984;288:1855-1857.Crossref 9. Mahler F, Saner H, Marth D, et al: Local cold exposure test for examination of the nailfold capillary circulation in Raynaud's syndrome. Inter Angio 1983;2:137-142. 10. Meier B, Mahler F, Bollinger A: Blutflussgeschwindigkeit in Nagelfalzkapillaren bei Gesunden und Patienten mit vasospastischen und organischen akralen Durchblutungsstörungen. Vasa 1978;7:194-198. 11. Bollinger A, Jäger K, Roten A, et al: Diffusion, pericapillary distribution and clearance of Na-fluorescein in the human nailfold. Pflugers Arch 1979;382:137-143. 12. Bollinger A, Frey J, Jäger K, et al: Patterns of diffusion through skin capillaries in patients with long-term diabetes. N Engl J Med 1982;307: 1305-1310.Crossref 13. Franzeck UK, Isenring G, Frey J, et al: Eine Apparatur zur dynamischen intravitalen Videomikroskopie. Vasa 1983;12:233-238. 14. Jäger K, Geser A, Bollinger A: Videodensitometrische Messung der transkapillären Passage und Gewebsverteilung von Na-Fluoreszein in menschlichen Hautkapillaren. Vasa 1980;9:132-136. 15. Bollinger A, Jäger K: Trans- and pericapillary diffusion of Na-fluorescein in scleroderma and chronic venous incompetence. Bibl Anat 1981;20:679-683. 16. Dagher FJ, Lyons JH, Finlayson DC, et al: Blood volume measurement: A critical study prediction of normal values: Controlled measurement of sequential changes. Adv Surg 1965;1:69-109. 17. Odland GF: The fine structure of cutaneous capillaries , in Montagna EW, Ellis RA (eds): Advances in Biology of Skin . Elmsford, NY, Pergamon Press Inc, 1961, vol 2, pp 57-70. 18. Intaglietta M, Johnson PC: Principle of capillary exchange , in Johnson PC (ed): Peripheral Circulation . New York, John Wiley & Sons Inc, 1978, pp 141-166. 19. Franzeck UK, Isenring G, Frey J, et al: Videodensitometric pattern recognition of Na-fluorescein diffusion in nailfold capillary areas of patients with acrocyanosis, primary and secondary Raynaud's phenomenon. Inter Angio 1983;2:143-152. 20. Chen Z-Y, Silver RM, Ainsworth SK, et al: Association between fluorescent antinuclear antibodies, capillary patterns, and clinical features in scleroderma spectrum disorders. Am J Med 1984;77:812-822.Crossref 21. Harper FE, Maricq HR, Turner RE, et al: A prospective study of Raynaud's phenomenon and early connective tissue disease: A five-year report. Am J Med 1982;72:883-888.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Aug 1, 1986

References